What is the role of anti–tumor necrosis factor (anti-TNF) agents in the treatment of Takayasu arteritis?

Updated: Nov 14, 2018
  • Author: Jefferson R Roberts, MD; Chief Editor: Herbert S Diamond, MD  more...
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Answer

Anti-TNF agents have shown encouraging results in a small number of patients with relapsing Takayasu arteritis. [47]

In an uncontrolled series of 15 patients, adjunctive treatment with anti-TNF agents was effective in patients with active, relapsing Takayasu arteritis despite treatment with steroids and multiple other immunosuppressive agents. [48] The initial dose of etanercept was 25 mg twice weekly (seven patients); infliximab (11 patients [three were switched from etanercept to infliximab]) was given at 3 mg/kg initially and at 2 weeks, 6 weeks, and then every 8 weeks thereafter. In nine of the 14 responders, an increase in the anti-TNF dosage was required to sustain remission.

The preliminary results of this study suggested that anti-TNF therapy may be a useful adjunct to corticosteroids in the treatment of patients with Takayasu arteritis.

In a review of nine patients with refractory Takayasu arteritis, Youngstein et al reported sustained responses to treatment with a TNF-α antagonist, an IL-6 receptor antagonist, or both. The mean duration of anti–TNF-α treatment was 42 months (maximum 8 years), and two patients maintained responses to IL-6 receptor inhibition at 19 and 20 months. [49]

During treatment, none of the patients showed significant progression in arterial injury, and significant decreases occurred in C-reactive protein level, prednisolone dose, and Indian Takayasu arteritis activity. As five of the nine patients had failed cyclophosphamide, the investigators recommended that therapies targeting TNF-α and the IL-6 receptor be considered ahead of cyclophosphamide. [49]


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